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Pelvic Inflammatory Disease (PID)

Pelvic inflammatory disease (PID) is an infection of a woman’s reproductive organs, including the uterus (womb), fallopian tubes, and ovaries. It happens when bacteria travel up from the vagina into the reproductive organs. Chlamydia and gonorrhea are sexually transmitted bacterial infections that commonly cause PID. According to the Canadian PID Society, almost 100,000 Canadian women get PID each year.

You can have PID and not know it. To find out if you have PID, you need to examined by a health care provider and have lab tests done.

PID is cured with antibiotics. If left untreated, PID can cause scarring in the pelvic organs and can lead to infertility and pain.

Causes

Bacteria from the vagina pass through the cervix and move up to the uterus and fallopian tubes. The most common ways to get PID are from:

  • Sexually transmitted infections, usually gonorrhea or chlamydia
  • Other non-sexually transmitted bacteria
  • Medical procedures such as abortion, D&C (dilatation and curettage), and IUD (intrauterine device) insertion that may introduce bacteria into the uterus or fallopian tubes

Symptoms

The most common symptom of PID is pain in the lower abdomen, usually on both sides. The pain may be crampy or a dull constant ache and it may be worse during sex, bowel movements, or when you urinate. Some women also have fever or chills, nausea or vomiting, lower back pain, abnormal fluid from the vagina (discharge), need to pee more often, and abnormal vaginal bleeding or spotting between periods.

Complications

If pelvic inflammatory disease is not caught early, there may be complications such as:

  • Long lasting pelvic pain
  • Trouble getting pregnant (infertility)
  • Increased chance of a tubal pregnancy (the egg attaches outside of the uterus)
  • Recurrent PID
  • Fitz-Hugh-Curis syndrome - a rare complication affecting the liver

Recurring infections are common and they increase the chance of long-term health problems. The risk of these complications increases each time you have a pelvic infection. Recurring infection can be caused by:

  • Inadequate treatment of the first infection
  • Failure to treat sexual partners

Tests and Diagnosis

If you have symptoms of PID, your health care provider will do a pelvic exam and take swabs to test for chlamydia and gonorrhea. During this exam, your health care provider will also feel for pain or tenderness in the internal organs.Your health care provider may send you for an ultrasound to look for other reasons for your symptoms.

Treatment

PID is treated with antibiotics. Occasionally, PID is severe enough that women will be admitted to the hospital for intravenous antibiotics. It is important to treat PID as soon as possible to prevent problems later on.

If your symptoms continue, you should go back to your health care provider in 3-7 days after you started treatment. If your symptoms get worse, seek immediate medical care (e.g., go to the hospital emergency). It is important to follow-up with your health care provider to make sure that the treatment worked and to prevent any problems later on.

If you or your sexual partners miss pills or have sex before you have finished your treatment, there is a chance that the infection will stay in your body and cause problems later. If this happens, talk with your health care provider to decide if you need further treatment.

Treatment for Partners

If you have PID, you will be asked who you had sex with in the past 2 months (60 days). Anyone you have had sex with in the past two months will need to be tested and treated. Partners are almost always given medication whether they have symptoms or not. If you have not had sex in the past two months, your last partner should be tested.

There are a few ways you can tell partners about STI testing. Some people want to tell partners in person, others want to tell partners anonymously. You can also talk to your health care provider about what ways might work best for you.

Avoid Re-infection or Prolonging Infection

It takes time for an infection to be cleared from the body, so it is important that you do not have oral, vaginal and anal sex for seven days after you and your partners start the antibiotic treatment. If you or your partners do not finish the treatment or miss pills, the infection may be passed back to you or your partners and may cause health problems later on. If that happens, talk with your health care provider to see if you or your partners need more treatment.

Resources

BC Centre for Disease Control – Pelvic Inflammatory Disease
HealthLink BC – Pelvic Inflammatory Disease

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PID, chlamydia, gonorrhea
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